Provider First Line Business Practice Location Address:
812 NORTH LOGAN AVENUE
Provider Second Line Business Practice Location Address:
PROVENA UNITED SAMARITANS MEDICAL - DIETARY DEPARTMENT
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-443-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2011